medigraphic.com
ISSN 2500-7106 (Digital)
ISSN 0123-2576 (Impreso)
Medicina & Laboratorio

2010, Número 03-04

<< Anterior Siguiente >>

Medicina & Laboratorio 2010; 16 (03-04)


Osteoporosis: enfoque clínico y de laboratorio

Molina RJF, González NLA

Idioma: Español
Referencias bibliográficas: 80
Paginas: 111-140
Archivo PDF: 789.63 Kb.


RESUMEN

La osteoporosis es una enfermedad esquelética sistémica caracterizada por baja masa ósea y deterioro de la microarquitectura del tejido óseo que predisponen a un mayor riesgo de fractura. La pérdida de hueso puede ocurrir como resultado de un desequilibrio entre la formación de hueso y la resorción ósea. Durante los primeros años después de la menopausia, las mujeres pueden tener una pérdida rápida de hueso. Esta pérdida posmenopáusica temprana se da principalmente como resultado de la mayor actividad de los osteoclastos, y colocan a las mujeres en un riesgo mayor que los hombres de fractura por osteoporosis. La osteoporosis se diagnostica clínica o radiológicamente. La osteoporosis clínicamente puede presentarse con fracturas por bajo impacto o por fracturas por fragilidad; sin embargo, se diagnostica más comúnmente con un resultado de densitometría ósea con un T-score de -2,5 o menos en cadera total, cuello femoral o columna lumbar. Los marcadores bioquímicos de recambio óseo aportan pruebas de utilidad clínica de los procesos normales o patológicos de la actividad de las células óseas en el esqueleto, y puede aportar pruebas sobre la eficacia de la terapia antirresortiva. En este módulo se resumen los aspectos básicos de la fisiología ósea y el proceso que conduce a la pérdida ósea. Se discuten también la epidemiología, patogénesis y manifestaciones clínicas de la osteoporosis, así como el enfoque diagnóstico para el paciente con pérdida de masa ósea. Por último, algunas estrategias para la prevención de la osteoporosis se mencionan brevemente.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Pietschmann P, Rauner M, Sipos W, Kerschan-Schindl K. Osteoporosis: an age-related and gender-specific disease--a mini-review. Gerontology 2009; 55: 3-12.

  2. Becker C. Pathophysiology and clinical manifestations of osteoporosis. Clin Cornerstone 2006; 8: 19-27.

  3. WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report 843. Geneva 1994.

  4. Czerwinski E, Badurski JE, Marcinowska-Suchowierska E, Osieleniec J. Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil 2007; 9: 337-356.

  5. Walker MD, Babbar R, Opotowsky AR, Rohira A, Nabizadeh F, Badia MD, et al. A referent bone mineral density database for Chinese American women. Osteoporos Int 2006; 17: 878-887.

  6. Man Z, Larroudé MS. Osteoporosis. In Molina J, Alarcón-Segovia D, Molina JF, Anaya JM,Cardiel MH. Texto de Reumatología, Fundamentos de Medicina (CIB). 6 ed, 2005: 456-481.

  7. Kasturi GC, Cifu DX, Adler RA. A review of osteoporosis: part I. Impact, pathophysiology, diagnosis and unique role of the physiatrist. PM R 2009; 1: 254-260.

  8. Ferrer Canabate J, Tovar I, Martinez P. [Osteoprotegrin and RANKL/RANK system: is it the future of bone metabolism?]. An Med Interna 2002; 19: 385-388.

  9. Seeman E, Delmas PD. Bone quality--the material and structural basis of bone strength and fragility. N Engl J Med 2006; 354: 2250-2261.

  10. Riggs BL, Khosla S, Melton LJ, 3rd. A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J Bone Miner Res 1998; 13: 763-773.

  11. Shoback D. Update in osteoporosis and metabolic bone disorders. J Clin Endocrinol Metab 2007; 92: 747-753.

  12. Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 2006; 194: S3-11.

  13. Gold DT. Introduction to osteoporosis: From pathogenesis to prevention and treatment strategies. Am J Obstet Gynecol 2006; 194: S1-S2.

  14. Simon LS. Osteoporosis. Rheum Dis Clin North Am 2007; 33: 149-176.

  15. Taxel P, Kenny A. Differential diagnosis and secondary causes of osteoporosis. Clin Cornerstone 2000; 2: 11-21.

  16. Sweet MG, Sweet JM, Jeremiah MP, Galazka SS. Diagnosis and treatment of osteoporosis. Am Fam Physician 2009; 79: 193-200.

  17. Riera-Espinoza G. Epidemiology of osteoporosis in Latin America 2008. Salud Publica Mex 2009; 51 Suppl 1: S52-55.

  18. Campuzano-Maya G, Uribe-Uribe O. Marcadores bioquímicos en osteoporosis: una nueva opción para su estudio. Medicina & Laboratorio 1997; 7: 71-90.

  19. Lash RW, Nicholson JM, Velez L, Van Harrison R, McCort J. Diagnosis and management of osteoporosis. Prim Care 2009; 36: 181-198, x.

  20. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, et al. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 2008; 11: 75-91.

  21. Lenchik L, Rogers LF, Delmas PD, Genant HK. Diagnosis of osteoporotic vertebral fractures: importance of recognition and description by radiologists. AJR Am J Roentgenol 2004; 183: 949-958.

  22. Álvarez T, Molina JF. Marcadores bioquímicos de remodelamiento óseo. In Osteoporosis: Enfoque línico y tratamiento. Vasquez Awad David (ed). Bogota 2008. Editora Guadalupe Ltda. pp 143-156.

  23. Woitge HW, Seibel MJ. Biochemical markers to survey bone turnover. Rheum Dis Clin North Am 2001; 27: 49-80.

  24. Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 2000; 11 Suppl 6: S2-17.

  25. Singer FR, Eyre DR. Using biochemical markers of bone turnover in clinical practice. Cleve Clin J Med 2008; 75: 739-750.

  26. Seibel MJ. Biochemical markers of bone remodeling. Endocrinol Metab Clin North Am 2003; 32: 83-113, vi-vii.

  27. Caulfield MP, Reitz RE. Biochemical markers of bone turnover and their utility in osteoporosis. MLO Med Lab Obs 2004; 36: 34-37.

  28. Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, et al. Endocrine regulation of energy metabolism by the skeleton. Cell 2007; 130: 456-469.

  29. Parfitt AM, Simon LS, Villanueva AR, Krane SM. Procollagen type I carboxy-terminal extension peptide in serum as a marker of collagen biosynthesis in bone. Correlation with Iliac bone formation rates and comparison with total alkaline phosphatase. J Bone Miner Res 1987; 2: 427-436.

  30. Prockop OJ, Kivirikko KI. Hydroxyproline and the metabolism of collagen. In Gould BS (ed), Treatise on Collagen, Vol 2. Academic Press, New York, 1968, pp 215-246. .

  31. Uebelhart D, Gineyts E, Chapuy MC, Delmas PD. Urinary excretion of pyridinium crosslinks: a new marker of bone resorption in metabolic bone disease. Bone Miner 1990; 8: 87-96.

  32. Beardsworth LJ, Eyre DR, Dickson IR. Changes with age in the urinary excretion of lysyl- and hydroxylysylpyridinoline, two new markers of bone collagen turnover. J Bone Miner Res 1990; 5: 671-676.

  33. Black D, Marabani M, Sturrock RD, Robins SP. Urinary excretion of the hydroxypyridinium cross links of collagen in patients with rheumatoid arthritis. Ann Rheum Dis 1989; 48: 641-644.

  34. Reiser K, McCormick RJ, Rucker RB. Enzymatic and nonenzymatic cross-linking of collagen and elastin. FASEB J 1992; 6: 2439-2449.

  35. Greenwald RA. Monitoring collagen degradation in patients with arthritis. The search for suitable surrogates. Arthritis Rheum 1996; 39: 1455-1465.

  36. Hanson DA, Weis MA, Bollen AM, Maslan SL, Singer FR, Eyre DR. A specific immunoassay for monitoring human bone resorption: quantitation of type I collagen cross-linked N-telopeptides in urine. J Bone Miner Res 1992; 7: 1251-1258.

  37. Clemens JD, Herrick MV, Singer FR, Eyre DR. Evidence that serum NTx (collagen-type I Ntelopeptides) can act as an immunochemical marker of bone resorption. Clin Chem 1997; 43: 2058-2063.

  38. Garnero P, Gineyts E, Riou JP, Delmas PD. Assessment of bone resorption with a new marker of collagen degradation in patients with me tabolic bone disease. J Clin Endocrinol Metab 1994; 79: 780-785.

  39. Christgau S, Rosenquist C, Alexandersen P, Bjarnason NH, Ravn P, Fledelius C, et al. Clinical evaluation of the Serum CrossLaps One Step ELISA, a new assay measuring the serum concentration of bone-derived degradation products of type I collagen C-telopeptides. Clin Chem 1998; 44: 2290-2300.

  40. Garnero P, Hausherr E, Chapuy MC, Marcelli C, Grandjean H, Muller C, et al. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res 1996; 11: 1531-1538.

  41. Hannon RA, Clowes JA, Eagleton AC, Al Hadari A, Eastell R, Blumsohn A. Clinical performance of immunoreactive tartrate-resistant acid phosphatase isoform 5b as a marker of bone resorption. Bone 2004; 34: 187-194.

  42. Meier C, Meinhardt U, Greenfield JR, De Winter J, Nguyen TV, Dunstan CR, et al. Serum cathepsin K concentrations reflect osteoclastic activity in women with postmenopausal osteoporosis and patients with Paget’s disease. Clin Lab 2006; 52: 1-10.

  43. Seibel MJ. Biochemical Markers of Bone Turnover Part II: Clinical Applications in the Management of Osteoporosis. Clin Biochem Rev 2006; 27: 123-138.

  44. Hofbauer LC, Heufelder AE. Role of receptor activator of nuclear factor-kappaB ligand and osteoprotegerin in bone cell biology. J Mol Med 2001; 79: 243-253.

  45. Khosla S, Arrighi HM, Melton LJ, 3rd, Atkinson EJ, O’Fallon WM, Dunstan C, et al. Correlates of osteoprotegerin levels in women and men. Osteoporos Int 2002; 13: 394-399.

  46. Leeming DJ, Alexandersen P, Karsdal MA, Qvist P, Schaller S, Tanko LB. An update on biomarkers of bone turnover and their utility in biomedical research and clinical practice. Eur J Clin Pharmacol 2006; 62: 781-792.

  47. Boyce BF, Xing L. Biology of RANK, RANKL, and osteoprotegerin. Arthritis Res Ther 2007; 9 Suppl 1: S1.

  48. Liberman UA, Weiss SR, Broll J, Minne HW, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995; 333: 1437-1443.

  49. Barreto FC, Barreto DV, Moyses RM, Neves CL, Jorgetti V, Draibe SA, et al. Osteoporosis in hemodialysis patients revisited by bone histomorphometry: a new insight into an old problem. Kidney Int 2006; 69: 1852-1857.

  50. Wichers M, Schmidt E, Bidlingmaier F, Klingmuller D. Diurnal rhythm of CrossLaps in human serum. Clin Chem 1999; 45: 1858-1860.

  51. Kenny AM, Prestwood KM, Biskup B, Robbins B, Zayas E, Kleppinger A, et al. Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women. Osteoporos Int 2004; 15: 290-294.

  52. Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003; 9: 544-564.

  53. Management of postmenopausal osteoporosis: position statement of the North American Menopause Society. Menopause 2002; 9: 84-101.

  54. Melton LJ, 3rd, Khosla S, Atkinson EJ, O’Fallon WM, Riggs BL. Relationship of bone turnover to bone density and fractures. J Bone Miner Res 1997; 12: 1083-1091.

  55. Riggs BL, Melton LJ, 3rd. Bone turnover matters: the raloxifene treatment paradox of dramatic decreases in vertebral fractures without commensurate increases in bone density. J Bone Miner Res 2002; 17: 11-14.

  56. Cons-Molina F. Marcadores bioquímicos de remodelado óseo. Rev Metab Oseo Min 2003; 1: 91-98.

  57. Bauer DC, Sklarin PM, Stone KL, Black DM, Nevitt MC, Ensrud KE, et al. Biochemical markers of bone turnover and prediction of hip bone loss in older women: the study of osteoporotic fractures. J Bone Miner Res 1999; 14: 1404-1410.

  58. Garnero P, Sornay-Rendu E, Duboeuf F, Delmas PD. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: the OFELY study. J Bone Miner Res 1999; 14: 1614-1621.

  59. Garnero P, Sornay-Rendu E, Chapuy MC, Delmas PD. Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis. J Bone Miner Res 1996; 11: 337-349.

  60. Bagger YZ, Tanko LB, Alexandersen P, Hansen HB, Mollgaard A, Ravn P, et al. Two to three years of hormone replacement treatment in healthy women have long-term preventive effects on bone mass and osteoporotic fractures: the PERF study. Bone 2004; 34: 728-735.

  61. Johansen JS, Riis BJ, Delmas PD, Christiansen C. Plasma BGP: an indicator of spontaneous bone loss and of the effect of oestrogen treatment in postmenopausal women. Eur J Clin Invest 1988; 18: 191-195.

  62. Gardsell P, Johnell O, Nilsson BE. The predictive value of bone loss for fragility fractures in women: a longitudinal study over 15 years. Calcif Tissue Int 1991; 49: 90-94.

  63. Bruyere O, Collette J, Delmas P, Rouillon A, Roux C, Seidel L, et al. Interest of biochemical markers of bone turnover for long-term prediction of new vertebral fracture in postmenopausal osteoporotic women. Maturitas 2003; 44: 259-265.

  64. Garnero P, Dargent-Molina P, Hans D, Schott AM, Breart G, Meunier PJ, et al. Do markers of bone resorption add to bone mineral density and ultrasonographic heel measurement for the prediction of hip fracture in elderly women? The EPIDOS prospective study. Osteoporos Int 1998; 8: 563-569.

  65. Akesson K, Ljunghall S, Jonsson B, Sernbo I, Johnell O, Gardsell P, et al. Assessment of biochemical markers of bone metabolism in relation to the occurrence of fracture: a retrospective and prospective population-based study of women. J Bone Miner Res 1995; 10: 1823-1829.

  66. Ross PD, Kress BC, Parson RE, Wasnich RD, Armour KA, Mizrahi IA. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study. Osteoporos Int 2000; 11: 76-82.

  67. Eastell R, Barton I, Hannon RA, Chines A, Garnero P, Delmas PD. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003; 18: 1051-1056.

  68. Hochberg MC, Greenspan S, Wasnich RD, Miller P, Thompson DE, Ross PD. Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 2002; 87: 1586-1592.

  69. Bauer DC, Black DM, Garnero P, Hochberg M, Ott S, Orloff J, et al. Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial. J Bone Miner Res 2004; 19: 1250-1258.

  70. Brown JP, Delmas PD, Malaval L. Serum bone GLA-protein: a specific marker of bone formation in postmenopausal osteoporosis. Presented at the Proceedings of the Copenhagen International Symposium on Osteoporosis. Glostrop Hospital, Denmark. 1984.

  71. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999; 282: 1344-1352.

  72. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 2000; 11: 83-91.

  73. Meier C, Nguyen TV, Center JR, Seibel MJ, Eisman JA. Bone resorption and osteoporotic fractures in elderly men: the dubbo osteoporosis epidemiology study. J Bone Miner Res 2005; 20: 579-587.

  74. Bonnick SL, Shulman L. Monitoring osteoporosis therapy: bone mineral density, bone turnover markers, or both? Am J Med 2006; 119: S25-31.

  75. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281.

  76. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, et al. Effect of Vitamin D on falls: a metaanalysis. JAMA 2004; 291: 1999-2006.

  77. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001; 22: 477-501.

  78. Hollis BW. Assessment of vitamin D status and definition of a normal circulating range of 25-hydroxyvitamin D. Curr Opin Endocrinol Diabetes Obes 2008; 15: 489-494.

  79. National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis. http://www.nof.org/professionals/Clinicians_Guide.htm. Accessed February 15, 2010.

  80. Mauck KF, Clarke BL. Diagnosis, screening, prevention, and treatment of osteoporosis. Mayo Clin Proc 2006; 81: 662-672.




2020     |     www.medigraphic.com